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Frontiers in Oncology 2021Pelvic exenteration performed for recurrent/persistent gynecological malignancies has been associated with urological short- and long-term morbidity due to altered...
INTRODUCTION
Pelvic exenteration performed for recurrent/persistent gynecological malignancies has been associated with urological short- and long-term morbidity due to altered vascularization of tissues for previous radiotherapy. The aims of the present study were to describe the use of intravenous indocyanine green (ICG) to assess vascularity of urinary diversion (UD) after pelvic exenteration for gynecologic cancers, to evaluate the feasibility and safety of this technique, and to assess the postoperative complications.
METHODS
Prospective, observational, single-center, pilot study including consecutive patients undergoing anterior or total pelvic exenteration due to persistent/recurrent gynecologic cancers between August 2020 and March 2021 at Fondazione Policlinico Gemelli IRCCS, Rome, Italy. All patients underwent intravenous injection of 3-6 ml of ICG (1.25 mg/ml) once the UD was completed. A near-infrared camera was used to evaluate ICG perfusion of anastomoses (ileum-ileum, right and left ureter with small bowel, and colostomy or colorectal sides of anastomosis) a few seconds after ICG injection.
RESULTS
Fifteen patients were included in the study. No patient reported adverse reactions to ICG injection. Only 3/15 patients (20.0%) had an optimal ICG perfusion in all anastomoses. The remaining 12 (80.0%) patients had at least one ICG deficit; the most common ICG deficit was on the left ureter: 3 (20.0%) vs. 1 (6.7%) patient had no ICG perfusion on the left vs. right ureter, respectively (p = 0.598). 8/15 (53.3%) and 6/15 (40.0%) patients experienced grade ≥3 30-day early and late postoperative complications, respectively. Of these, two patients had early and one had late postoperative complications directly related to poor perfusion of anastomosis (UD leak, ileum-ileum leak, and benign ureteric stricture); all these cases had a suboptimal intraoperative ICG perfusion.
CONCLUSION
The use of ICG to intraoperatively assess the anastomosis perfusion at time of pelvic exenteration for gynecologic malignancy is a feasible and safe technique. The different vascularization of anastomotic stumps may be related to anatomical sites and to previous radiation treatment. This approach could be in support of selecting patients at higher risk of complications who may need personalized follow-up.
PubMed: 34950574
DOI: 10.3389/fonc.2021.727725 -
Frontiers in Plant Science 2021The height growth of the trees depends on sufficient mechanical support given by the stem and an effective hydraulic system. On unstable slopes, tree growth is affected...
The height growth of the trees depends on sufficient mechanical support given by the stem and an effective hydraulic system. On unstable slopes, tree growth is affected by soil pressure from above and potential soil erosion from below the position of tree. The necessary stabilization is then provided by the production of mechanically stronger wood of reduced hydraulic conductivity. Unfortunately, the interaction between tree growth (both radial and axial) and stabilization in the soil is still insufficiently understood. Therefore, in this study, we aimed to quantify the impact of hillslope dynamics on the degree of tree growth and hydraulic limitation, and the potential effect on tree height growth and growth plasticity. To evaluate this effect, we took four cores from 80 individuals of and and measured tree-ring widths (TRWs) and vessel lumen areas (VLAs). The tree heights were evaluated using a terrestrial laser scanner, and local soil depth was measured by a soil auger. Our data showed a significant limitation of the tree hydraulic system related with the formation of eccentric tree-rings. The stem eccentricity decreased with increasing stem diameter, but at the same time, the negative effect of stem eccentricity on conduit size increased with the increasing stem diameter. Even though this anatomical adaptation associated with the effect of stem eccentricity differed between the tree species (mainly in the different degree of limitations in conduit size), the trees showed an increase in the proportion of hydraulically inactive wood elements and a lowered effectiveness of their hydraulic system. In addition, we observed a larger negative effect of stem eccentricity on VLA in . We conclude that the stabilization of a tree in unstable soil is accompanied by an inability to create sufficiently effective hydraulic system, resulting in severe height-growth limitation. This affects the accumulation of aboveground biomass and carbon sequestration.
PubMed: 34925420
DOI: 10.3389/fpls.2021.778802 -
BMJ Case Reports Nov 2021A 14-year-old boy with 22q11.2 deletion syndrome and a right ventricular to pulmonary artery xenograft conduit presented to an Australian tertiary children's hospital...
A 14-year-old boy with 22q11.2 deletion syndrome and a right ventricular to pulmonary artery xenograft conduit presented to an Australian tertiary children's hospital with prolonged fevers, weight loss, splenomegaly and a high proportion of gamma-delta T cells in peripheral blood and bone marrow, concerning for possible gamma-delta T-cell lymphoma. However, investigations did not reveal evidence of lymphoma or autoimmune disease. After 5 months of intermittent fever episodes and ongoing symptoms, he was found to have an extremely high titre (8192) on serological testing, with the organism also detected on blood PCR. After 6 months of oral azithromycin and rifampicin, with complete resolution of his symptoms 3 months into treatment, his blood PCR was negative and gamma-delta T cells in peripheral blood were decreasing. The titre remained unchanged for some time, but decreased to 2048 around 1 year after treatment was started.
Topics: Adolescent; Australia; Bartonella henselae; Cat-Scratch Disease; Child; DiGeorge Syndrome; Humans; Lymphoma; Lymphoma, T-Cell; Male; T-Lymphocytes
PubMed: 34848411
DOI: 10.1136/bcr-2021-245592 -
American Journal of Botany Nov 2021Environmental gradients of mountains are reflected in traits that are common to high-elevation plants worldwide. Closely related species of Senecio from the equatorial...
PREMISE
Environmental gradients of mountains are reflected in traits that are common to high-elevation plants worldwide. Closely related species of Senecio from the equatorial Andes grow as broad-leaved climbers in montane forests, basal broad-leaved rosette herbs in azonal marshy habitats, and ascending, narrow-leaved subshrubs in high-elevation páramo. Habitat variation along the elevational gradient enables testing whether modifications in leaf and stem functional traits among species were driven by contrasting environmental conditions.
METHODS
We used quantitative analyses to describe changes in morphological and anatomical traits of leaves and stems in 10 species from various habitats. We applied univariate (linear regression, hierarchical ANOVA) and multivariate (NMDS ordination, permutational MANOVA) techniques to examine the correlation of traits with the species' habitats and elevation.
RESULTS
Species from the humid and frost-free montane forest develop xylem optimized for transport efficiency by increasing the internal diameter and length of the conduits. In contrast, páramo species are optimized toward hydraulic safety by producing narrower conduits and are more likely to prevent the risk of frost-induced cavitation. Moreover, species from the high-elevation páramo habitats present a set of water-transport-related anatomical traits of leaf lamina, allowing for efficient regulation of transpiration losses.
CONCLUSIONS
Morphological and anatomical traits of leaves and stems in species of Senecio inhabiting montane forests and high-elevation páramo in the equatorial Andes demonstrate a trade-off between hydraulic safety and efficiency of water transport.
Topics: Adaptation, Physiological; Plant Leaves; Plants; Trees; Water; Xylem
PubMed: 34787899
DOI: 10.1002/ajb2.1799 -
European Journal of Vascular and... Dec 2021Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic... (Comparative Study)
Comparative Study
Editor's Choice - Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study.
OBJECTIVE
Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study.
METHODS
The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 and May 2017. The primary aim was to compare short and long term survival, as well as complications for EAB and ISR.
RESULTS
Some 126 radically surgically treated AGI patients were identified - 102 graft infections and 24 endograft infections - treated by EAB: 71 and ISR: 55 (23 neo-aorto-iliac systems, NAISs). No differences in early 30 day (EAB 81.7% vs. ISR 76.4%, p = .46), or long term five year survival (48.2% vs. 49.9%, p = .87) were identified. There was no survival difference comparing NAIS to other ISR strategies. The frequency of recurrent graft infection during follow up was similar: EAB 20.3% vs. ISR 17.0% (p = .56). Survival and re-infection rates of the new conduit did not differ between NAIS and other ISR strategies. Age ≥ 75 years (odds ratio [OR] 4.0, confidence interval [CI] 1.1 - 14.8), coronary artery disease (OR 4.2, CI 1.2 - 15.1) and post-operative circulatory complications (OR 5.2, CI 1.2 - 22.5) were associated with early death. Prolonged antimicrobial therapy (> 3 months) was associated with reduced long term mortality (HR 0.3, CI 0.1 - 0.9).
CONCLUSION
In this nationwide multicentre study comparing outcomes of radically treated AGI, no differences in survival or re-infection rate could be identified comparing EAB and ISR.
Topics: Aged; Aorta, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Middle Aged; Prosthesis-Related Infections; Registries; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Sweden; Time Factors; Treatment Outcome
PubMed: 34782231
DOI: 10.1016/j.ejvs.2021.09.033 -
Frontiers in Plant Science 2021Treeline ecosystems are of great scientific interest to study the effects of limiting environmental conditions on tree growth. However, tree growth is multidimensional,...
Treeline ecosystems are of great scientific interest to study the effects of limiting environmental conditions on tree growth. However, tree growth is multidimensional, with complex interactions between height and radial growth. In this study, we aimed to disentangle effects of height and climate on xylem anatomy of white spruce [ (Moench) Voss] at three treeline sites in Alaska; i.e., one warm and drought-limited, and two cold, temperature-limited. To analyze general growth differences between trees from different sites, we used data on annual ring width, diameter at breast height (DBH), and tree height. A representative subset of the samples was used to investigate xylem anatomical traits. We then used linear mixed-effects models to estimate the effects of height and climatic variables on our study traits. Our study showed that xylem anatomical traits in white spruce can be directly and indirectly controlled by environmental conditions: hydraulic-related traits seem to be mainly influenced by tree height, especially in the earlywood. Thus, they are indirectly driven by environmental conditions, through the environment's effects on tree height. Traits related to mechanical support show a direct response to environmental conditions, mainly temperature, especially in the latewood. These results highlight the importance of assessing tree growth in a multidimensional way by considering both direct and indirect effects of environmental forcing to better understand the complexity of tree growth responses to the environment.
PubMed: 34759941
DOI: 10.3389/fpls.2021.748055 -
Diagnostic and Interventional Imaging Feb 2022Postoperative imaging plays a key role in the identification of complications after Ivor-Lewis esophagectomy (ILE). Careful analysis of imaging examinations can help... (Review)
Review
Postoperative imaging plays a key role in the identification of complications after Ivor-Lewis esophagectomy (ILE). Careful analysis of imaging examinations can help identify the cause of the presenting symptoms and the mechanism of the complication. The complex surgical procedure used in ILE results in anatomical changes that make imaging interpretation challenging for many radiologists. The purpose of this review was to make radiologists more familiar with the imaging findings of normal anatomical changes and those of complications following ILE to enable accurate evaluation of patients with an altered postoperative course. Anastomotic leak, gastric conduit necrosis and pleuropulmonary complications are the most serious complications after ILE. Computed tomography used in conjunction with oral administration of contrast material is the preferred diagnostic tool, although it conveys limited sensitivity for the diagnosis of anastomotic fistula. In combination with early endoscopic assessment, it can also help early recognition of complications and appropriate therapeutic management.
Topics: Anastomotic Leak; Esophageal Neoplasms; Esophagectomy; Humans; Postoperative Complications; Retrospective Studies
PubMed: 34654670
DOI: 10.1016/j.diii.2021.09.003 -
Journal of Experimental Botany Jan 2022Conifers face increased drought mortality risks because of drought-induced embolism in their vascular system. Variation in embolism resistance may result from species...
Conifers face increased drought mortality risks because of drought-induced embolism in their vascular system. Variation in embolism resistance may result from species differences in pit structure and function, as pits control the air seeding between water-transporting conduits. This study quantifies variation in embolism resistance and hydraulic conductivity for 28 conifer species grown in a 50-year-old common garden experiment and assesses the underlying mechanisms. Conifer species with a small pit aperture, high pit aperture resistance, and large valve effect were more resistant to embolism, as they all may reduce air seeding. Surprisingly, hydraulic conductivity was only negatively correlated with tracheid cell wall thickness. Embolism resistance and its underlying pit traits related to pit size and sealing were more strongly phylogenetically controlled than hydraulic conductivity and anatomical tracheid traits. Conifers differed in hydraulic safety and hydraulic efficiency, but there was no trade-off between safety and efficiency because they are driven by different xylem anatomical traits that are under different phylogenetic control.
Topics: Biological Transport; Droughts; Phylogeny; Tracheophyta; Water; Xylem
PubMed: 34626106
DOI: 10.1093/jxb/erab449 -
Frontiers in Pediatrics 2021The anatomic variation of hepatic vein in the left lateral segment (LLS) increases the risk of outflow complication in pediatric living liver transplantation (LDLT)....
The anatomic variation of hepatic vein in the left lateral segment (LLS) increases the risk of outflow complication in pediatric living liver transplantation (LDLT). Here, we share a modified method for dual hepatic vein reconstruction in pediatric LDLT using LLS with two wide orifices. From Sep 2018 to Dec 2019, 434 pediatric LDLTs using LLS were performed in our center. Hepatic veins of grafts were classified into three types with emphasis on the number, size, and location of orifices at the cut surface: a single opening (type I, = 341, 78.57%); two adjacent orifices (type II, = 66, 15.21%); two wide orifices with orifices distances <20 mm (type IIIa, = 15, 3.46%); and two wide orifices with orifices distances >20 mm (type IIIb, = 12, 2.76%). Rv was defined as the ratio of diameter of V2 and V3 (refer to hepatic vein drained segments II and III). We developed a modified dual hepatic vein anastomosis to reconstruct outflow for type IIIb grafts with Rv ≤1. Briefly, the hepatic vein of segment II was anastomosed to the common stump of middle hepatic vein (MHV) and left hepatic vein (LHV), followed by unification of V3 and the longitudinal incision orifice in inferior venous cave (IVC). During median follow-up of 15.6 months (7.5-22.9 months), no hepatic vein complications occurred. This novel modified dual hepatic vein anastomosis could serve as a feasible surgical option for type IIIb LLS grafts with Rv ≤1 in pediatric LDLT.
PubMed: 34604134
DOI: 10.3389/fped.2021.685956 -
JACC. Clinical Electrophysiology Mar 2022This study sought to describe the electrophysiologic properties and catheter ablation outcomes for atrioventricular reciprocating tacchycardia via twin atrioventricular...
OBJECTIVES
This study sought to describe the electrophysiologic properties and catheter ablation outcomes for atrioventricular reciprocating tacchycardia via twin atrioventricular nodes (T-AVRT).
BACKGROUND
Although catheter ablation for T-AVRT is an established entity, there are few data on the electrophysiological properties and outcomes of this procedure.
METHODS
An international, multicenter study was conducted to collect retrospective procedural and outcomes data for catheter ablation of T-AVRT.
RESULTS
Fifty-nine patients with T-AVRT were identified (median age at procedure, 8 years [interquartile range: 4.4-17.0 years]; 49% male). Of these, 55 (93%) were diagnosed with heterotaxy syndrome (right atrial isomerism in 39, left atrial isomerism in 8, and indeterminate in 8). Twenty-three (39%) had undergone Fontan operation (12 extracardiac, 11 lateral tunnel). After the Fontan operation, atrial access was conduit or baffle puncture in 15 (65%), fenestration in 5 (22%), and retrograde in 3 (13%). Acute success was achieved in 43 (91%) of 47 attempts (targeting an anterior node in 23 and posterior node in 24). There was no high-grade AV block or change in QRS duration. Over a median of 3.8 years, there were 3 recurrences. Of 7 patients with failed index procedure or recurrent T-AVRT, 6 (86%) were associated with anatomical hurdles such as prior Fontan or catheter course through an interrupted inferior vena cava-to-azygous vein continuation (P = 0.11).
CONCLUSIONS
T-AVRT can be targeted successfully with low risk for recurrence. Complications were rare in this population. Anatomical challenges were common among patients with reduced short and long-term efficacy, representing opportunities for improvement in procedural timing and planning.
Topics: Atrioventricular Node; Cardiomyopathies; Catheter Ablation; Female; Fontan Procedure; Humans; Male; Retrospective Studies; Tachycardia, Reciprocating
PubMed: 34600852
DOI: 10.1016/j.jacep.2021.08.004